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Postop Care

postoperative period begins immediately after surgery and continues until the patient is discharged from medical care
How a patient moves through the phases of care in PACU is determined by the patient's condition
If a patient is stable and recovering well, they may progress through the PACU phases rapidly. This is refered to as (RPP) rapid postanesthesia care unit progression; can occur with either in- or outpatients
fast-tracking reduces overall costs, recovery time, and medical morbidity. How is this done? involves admitting ambulatory surgery patients who have received general, regional, or local anesthesia directly to phase II care
PACU Phase I (Initial Assessment) begins with evaluation of the ABC status; identify signs of inadequate oxygenation and ventilation
greatest value of pulse oximetry monitoring provides an early warning of hypoxemia and changes in arterial blood gases
PACU priority care includes monitoring and managing respiratory and circulatory function, pain, temperature, and the surgical site
protocol for deviations in ECG results from preoperative findings include measuring and comparing BP to baseline (invasive monitoring is initiated only if needed); assess body temp, capillary refill, and skin condition (color, moisture)
initial PACU neurologic assessment focuses on level of consciousness, orientation, sensory and motor status, and size, equality, and reactivity of pupils
initial PACU urinary system assessment focuses on intake (intraoperative fluid totals), output, and fluid balance; note IV lines, irrigation solutions & infusions; wound drains and catheters
initial PACU surgical site (wound) assessment focuses on the condition of any dressings and the type and amount of any drainage
the goal of PACU care identify actual and potential patient problems that may occur as a result of anesthetic admin and surgical intervention, and to intervene appropriately.
the primary postop problem (most common cause of postop hypoxia) atelectasis (bronchial obstruction caused by retained secretions or decrease lung volumes); alveolar collapse
patient manifestations of atelectasis decrease breath sounds; decrease or low O2 saturation
atelectasis interventions humidified O2, deep breathing, incentive spirometry, and early mobilization
pulmonary embolism, a major postop complication, is caused by a thrombus dislodging from the peripheral venous system; lodges in pulmonary arterial system
pulmonary embolism patient manifestations acute tachypnea, dyspnea, tachycardia, hypotension, bronchospasm, and decrease O2 sat
pulmonary embolism interventions O2 therapy, cardiopulmonary support, anticoagulant therapy
hypoxemia, specifically a PaO2 <60 mmHg is characterized by agitation to somnolence, hypo- to hypertension, tachy- to bradycardia; ABG analysis should be used to confirm hypoxia if pulse oximetry is <92%
other causes of hypoxemia bronchospasm, hypoventilation, pulmonary edema, aspiration (gastric contents)
positioning of the unconscious patient lateral "recovery" (side lying); keeps an open airway and reduces the risk of aspiration if vomiting occurs
positioning of the conscious patient supine with head of the bed raised; maximizes expansion of the thorax by decreasing the pressure of the abdominal contents on the diaphragm
emergence delirium (waking up wild) postop neurologic alteration that causes most concern; if occurs, suspect hypoxia first
causes of emergence delirium anesthetic agents, hypoxia, bladder distention, pain, residual neuromuscular blockade, presence of an endotracheal tube
changing a patient's position every 1 to 2 hours allows for full chest expansion and increases perfusion of both lungs
deep breathing and coughing aid in gas exchange to promote the retun to consciousness, help prevent atelectasis, and move respiratory secretions to larger passages for expectoration
most common cardiovascular PACU problems hypo- and hypertension, dysrhythmias
postop fluid and electrolyte imbalances contribute to cardiovascular problems. These imbalances develop as a result of the body's normal response to stress, excessive fluid losses, and improper IV fluid replacement
postop congnitive dysfunction (POCD) a decline in the patient's cognitive function for weeks or months after surgery; almost exclusively seen in the older patient
deep visceral pain results from pressure in the internal viscera and may signal the presence of complications such as intestinal distention, bleeding , or abscess formation
causes of postop hypothermia (temp <95 degrees F), up to 12 hrs after surgery effects of anesthesia, body heat loss during surgical procedure
causes of postop mild elevation of temp (up to 100.4) the first 48 hrs or days 1 & 2 inflammatory response to surgical stress
causes of postop moderate elevation of temp (above 100.4 degrees F) the first 48 hrs or days 1 & 2 lung congestion, atelectasis, dehydration
causes of postop elevation of temp (above 100 degrees F) after the first 48 hrs or day 3 and later infection (ex. wound, UTI, respiratory, etc)
stress related hormones such as cortisol have catabolic effects on the body, releasing amino acids. This helps with wound healing
evidence of wound infections usually manifest after the 3rd to 5th day. Local and systemic manifestations include Local: redness, swelling, increased pain and tenderness at the site; Systemic: fever and leukocytosis
expected urine output from a catheter clear, yellow in color; odor of ammonia; watery consistency; 800-1500 ml first 24hrs (minimal expected output is 0.5 ml/kg/hr)
expected gastric contents drainage from nasogastric tube/gastrostomy tube up to 1500 ml/day; sour odor; watery consistency; pale, yellow green, bloody following gastrointestinal surgery
expected drainage of bile from a t-tube 500 ml; bright yellow to dark green in color; acid odor; thick consistency
expected wound drainage from a hemovac odor same as the wound dressing; consistency varies; amount varies w/ procedure but may decrease over hrs to days; color varies with procedure(sanguineous or serosanguinous, changing to serous)
wound dehiscence separation and disruption of previously joined wound edges; may be preceded by a sudden discharge of brown, pink, or clear drainage
Created by: ashanti20
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